Percutaneous valvuloplasty in tricuspid valve stenosis]

This report describes the first successful case of tricuspid valve stenosis by percutaneous double balloon valvuloplasty in Mexico. The gradient decreased from 5 to 0 mmHg, with an increase in valve area by echocardiography and improvement of the jugular vein pulse and disappearance of symptoms. The feasibility of the balloon percutaneous valvuloplasty was demonstrated unequivocally.     

Combined mitral and tricuspid valve repair in acute infective endocarditis.

Combined repair of the mitral and tricuspid valves involved with acute infective endocarditis was carried out in a 38-year-old drug addict. Mitral valve repair included vegetectomy, closure of posterior leaflet perforation, and posterior annuloplasty with a patch and a strip of glutaraldehyde-tanned autologous pericardium, respectively, while the tricuspid valve was reconstructed with the use of artificial chordae and valve bicuspidalization. At five months follow up the patient is asymptomatic, with echocardiographic evidence of only trivial mitral and tricuspid incompetence, and no signs of recurrent infection. This case report supports the use of valve reconstruction as a valuable option in patients in whom there is simultaneous involvement of the mitral and tricuspid valves with infective endocarditis.     

Balloon valvuloplasty for fungal endocarditis induced stenosis of a bioprosthetic tricuspid valve

Palliative treatment was provided without complications by double balloon valvuloplasty of a stenotic porcine tricuspid valve in a patient with fungal endocarditis. With two 15 mm diameter valvulotomy balloons the peak tricuspid gradient decreased from 21 to 7 mm Hg and valve area increased from 0.3 to 1.2 cm². After the procedure the patient clinically improved; however, valve replacement was not performed as planned because the patient developed an intracranial hemorrhage. She subsequently died of complications of fungemia. The present report demonstrates the possible use of valvuloplasty as a palliative procedure in selected patients with valvular stenosis involved with endocarditis.     

Bidirectional superior cavopulmonary anastomosis: how young is too young?

OBJECTIVE--To define the lowest age at which the bidirectional superior cavopulmonary anastomosis can safely be used in infants with complex congenital heart defects. DESIGN--A retrospective analysis of clinical, echocardiographic, haemodynamic, and angiographic data in four consecutive patients undergoing bidirectional superior cavopulmonary anastomosis below the age of 2 months. PATIENTS--Between November 1990 and September 1993, four infants less than 8 weeks of age (3, 4, 6, and 7 weeks) underwent bidirectional superior cavopulmonary anastomosis as a primary palliation for complex heart disease. The indication for early surgical intervention was progression of cyanosis (n = 3) and high pulmonary blood flow causing heart failure (n = 1). In two infants with tricuspid atresia, surgery was performed through a right thoracotomy without the use of cardiopulmonary bypass. In one infant with double inlet left ventricle and discordant ventriculoarterial connection, cavopulmonary anastomosis was combined with an arterial switch procedure. The final infant had double inlet left ventricle with pulmonary atresia; the central pulmonary arteries were virtually discontinuous and each branch was supplied by a separate arterial duct. The central pulmonary arteries were reconstructed using the subaortic innominate vein. Temporary prostacyclin infusion was used in three patients in the immediate postoperative period. RESULTS--Early postoperative extubation (5, 7, and 48 h) was successful in three patients. The youngest child required ligation of the ductus arteriosus four days later because of severe upper body oedema. The postoperative course was complicated by prolonged effusions in two patients. All were alive and well 14-48 months postoperatively, with satisfactory systemic saturations (80-87%) and haemodynamic indices. CONCLUSIONS--This limited experience challenges the widely held belief that the bidirectional superior cavopulmonary anastomosis cannot be used as a primary palliation for complex heart disease in early infancy. A wider experience is required to determine the safety and indications for this approach.     

Balloon valvuloplasty for fungal endocarditis induced stenosis of a bioprosthetic tricuspid valve.

Palliative treatment was provided without complications by double balloon valvuloplasty of a stenotic porcine tricuspid valve in a patient with fungal endocarditis. With two 15 mm diameter valvulotomy balloons the peak tricuspid gradient decreased from 21 to 7 mm Hg and valve area increased from 0.3 to 1.2 cm2. After the procedure the patient clinically improved; however, valve replacement was not performed as planned because the patient developed an intracranial hemorrhage. She subsequently died of complications of fungemia. The present report demonstrates the possible use of valvuloplasty as a palliative procedure in selected patients with valvular stenosis involved with endocarditis.     

Intraoperative echocardiography in mitral and tricuspid valve repair

Echocardiography with Doppler color flow mapping is a very useful intraoperative technique in patients undergoing mitral or tricuspid valve repair. In the patient who is a repair candidate, this technique can be used intraoperatively to answer important clinical questions: the severity of the regurgitation; the morphological basis of the regurgitant lesion; and the feasibility of repair. Other important issues such as the impact of physiological interventions on regurgitation severity, the presence of associated lesions, and the state of ventricular function can also be addressed. In the patient who has undergone a valve repair, this technique can be used intraoperatively prior to chest closure to assess the adequacy of the repair procedure and to detect associated complications such as outflow tract obstruction.     

Percutaneous valvuloplasty for severe bioprosthetic tricuspid valve stenosis in the setting of infective endocarditis

Bioprosthetic tricuspid valve stenosis as a sequela of infective endocarditis is extremely rare. We describe the case of a 29‐year‐old male patient with a history of intravenous drug use and two previous bioprosthetic tricuspid valve placements who presented with recurrent endocarditis and severe tricuspid stenosis. He was deemed extremely high risk for redo valve replacement surgery. Intracardiac ultrasound‐guided balloon valvuloplasty was performed with good clinical outcome. We believe that interventional treatment of prosthetic valvular stenosis in the setting of endocarditis is a reasonable therapeutic choice when open surgical repair is associated with prohibitively high mortality. This can be performed either as destination therapy or as a bridge to valve replacement. The use of intracardiac ultrasound provided additive information to that obtained by transthoracic and transesophageal echocardiography. © 2014 Wiley Periodicals, Inc.     

De Vega annuloplasty for tricuspid valve repair in posttraumatic tricuspid insufficiency--16 years experience

Posttraumatic tricuspid insufficiency (PTI) is an uncommon clinical condition and frequently difficult to diagnose due to latent development of cardiac symptoms. The selection of an appropriate surgical treatment for PTI has been controversial. A simple and effective method of choice is De Vega tricuspid annuloplasty. We report here the excellent surgical result of a tricuspid valve repair using De Vega annuloplasty at a 16-year follow-up in a patient who developed PTI as a complication of blunt chest trauma. In conclusion De Vega tricuspid annuloplasty can be recommended for tricuspid reconstruction.     

Valve injury and repair in balloon aortic valvuloplasty

Aortic valves 0.5, and 4.5 months after successful percutaneous balloon aortic valvuloplasty (BAV) were examined. BAV caused macroscopic and microscopic fractures in calcific deposits. An inflammatory response was identified that may lead to valvular scarring. This process may be an important factor in the development of restenosis after BAV.